{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY N GRAVELY","gend":1,"add":"1116 DREWRY RD","city":"MARTINSVILLE","state":"VA","zip":"24112-4501","dob":"1986-07-30","age":"","mstatus":"","insh":11002811,"cliId":"5VR5AA9CH78","pno":2763404975,"cno":2763402065,"email":"","ename":"","eno":"","pphy":"PALLONE, AMANDA W","ppno":2766703300,"pcpadd":"1107 Brookdale St # A","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241124501,"pcpcounty":"","pcpid":"P0117819","pcpname":"CARILION MEDICAL ASSOCIATES MARTINSVILLE","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICARE","lob":"DSNP","region":"ROANOKE\/ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1116 DREWRY RD","madd2":"","madd3":"","mcity":"MARTINSVILLE","mstate":"VA","mzip":"24112-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N91.2","Z30.42","R07.89","R05","J20.9","N39.0","R07.9","S29.011A","S13.4XXA","M62.830","M79.601","R20.8","K21.9","Z32.02","J06.9","F79","J01.90","R00.0","E03.9","R51","J30.1","S20.219A","V49.50XA","I10","Z79.899","M54.2","X58.XXXA","R73.03","R12","E66.9","M54.9","N72","Z12.4","Z01.419","Z13.6","K02.9","Z91.89","V43.62XA","A41.9","N12","N20.1","N17.9","E86.0","E87.6","B96.20","N16","N20.2","N13.2","N20.0","R10.84","Z20.822","L27.0","T36.8X5A","Z87.448","R94.31","R10.9","R50.9","V58.2XXD","Z23","R11.2","R21","T78.40XA","R10.33","L53.9","R63.0","N94.6"],"date":["2020-01-22","2021-06-07","2020-05-07","2019-01-26","2019-01-26","2021-04-22","2020-10-10","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2019-02-03","2020-05-07","2019-02-03","2018-02-15","2021-03-26","2020-03-13","2021-04-02","2021-06-07","2020-04-24","2020-11-19","2020-10-10","2020-10-08","2020-10-08","2020-10-08","2021-01-18","2020-10-10","2020-11-19","2019-11-12","2019-11-12","2021-01-18","2018-12-19","2018-12-19","2018-12-19","2018-12-19","2018-12-19","2018-12-19","2020-10-08","2021-03-28","2021-04-02","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-04-22","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-22","2021-04-02","2020-11-19","2020-11-19","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-06-07"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","54001829","PREDNISONE","TAB 20MG","","Select","Select",""],["","172572960","FAMOTIDINE","TAB 40MG","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","378180910","LEVOTHYROXIN","TAB 100MCG","","Select","Select",""],["","59762453701","MEDROXYPR AC","INJ 150MG\/ML","","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","591565810","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","64380080438","RANITIDINE","TAB 300MG","","Select","Select",""],["","93221001","SUCRALFATE","TAB 1GM","","Select","Select",""],["","65862050220","AMOX\/K CLAV","TAB 500-125","","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","93031401","KETOROLAC","TAB 10MG","","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","93005805","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","28","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","7","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","54001829","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","59762453702","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","378180910","LEVOTHYROXIN ","TAB 100MCG","90","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","20","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","93031401","KETOROLAC ","TAB 10MG","15","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","10","Select","Select",""],["","591565810","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","93005805","TRAMADOL ","TAB 50MG","15","Select","Select",""],["","64380080438","RANITIDINE ","TAB 300MG","30","Select","Select",""],["","93221001","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}